My team went to Tengani, about half an hour north of here. We passed through grasslands with scattered tall trees fortunate enough to escape being chopped down for firewood, the rest were tiny bushes which suffered periodic chopping and never were able to grow any bigger. The mango trees fared better since they bore fruits that could bring in some cash although they too suffered some amount of slashing. The baobab trees with their thick trunks challenged anyone to put an axe to chop them down. They were attacked only when the hollow ones fell during a storm and the locals had a slow burn of the trunks to make charcoal for sale.
About a hundred meters from the tarmac road ran the defunct railway track. This track started from Lilongwe, the capital all the way south to Mozambique. The driver said trains used to travel from Limbe to Nsanje but two years ago it stopped because the Shire River flooded and destroyed the track. Over a dry riverbed part of the track floated in the air with all its trestles washed away. A vandalized train station with no roof and broken and mildewed walls stood forlornly by the track. It looked as though it must have been more than fifteen years since the train stopped running. The driver assured me that “they” were ready to fix the tracks soon...I took this in with a large grain of salt.
In the hot sun some villagers sat or stood by the road sides selling small amounts of produce; a few papayas, a cluster of tomatoes; on the opposite side of the road, someone just left a small basin of beans with a scooper for sale to passer buyers. Vehicles were few and far between, one wondered how many kwachas were they able to collect selling such small quantities of goods.
At the sign of Tengani we turned off from the tarmac to a dirt road and soon passed a cluster of buildings marked Nsanje District, Agriculture Office, Resource Center. The windows and doors were broken, some windows were just literally ripped off the buildings; it was obvious that no one worked there anymore. In the afternoon when we passed by again, a truck had just delivered forty to fifty sacks of something stacked neatly on the veranda of one of the buildings.
Tengani Health Center was in an enclosed compound. One huge chunk of the eaves was missing and another hanging precariously from the roof, it was only prevented from falling off by a vertical drainpipe and another hanging precariously from the roof. There were two rows of buildings. One housed the Men and Women Wards which were no longer working as wards, outpatient Department (OPD), the antenatal clinic and then the Maternity Ward which was divided into the Antenatal, Labor and Delivery and the Postnatal Wards. A broken roof beam in the OPD was splinted together with metal bars from parts of a wheelchair and dangled dangerously over where the patients sat.
The six rusty beds in the Antenatal Ward were without mattresses, the mid-wife told us they no longer used it. On the floor was a sterilizer looking somewhat abandoned but it was actually used for sterilizing instruments. There were six pairs of florescent light fixtures but only one lamp left, some fixtures had wires hanging out. When the lamp from the other wards burned out, the lamps from the Antenatal Ward were systematically stripped leaving it with its last lamp. The counter of the two sinks in the Labor and Delivery room was cluttered with a baby weighing scale, rags, basins, and used instruments. It had two beds and it did not look like it was ready for the next birth. On the wall of one of the cabinets was a hand-written note on “How to Deliver a Baby”, there was a notation about providing a clean, warm and well-lit space for the newborn…The postnatal Ward had four beds with mattresses and bed nets. The floor was sparklingly clean and there was no bad odor.
The midwife in the antenatal clinic dragged out the one-year-old brand-new unused sterilizer from the storage room which was dark as there was no light bulb in there. The sterilizer had a plug that did not fit the wall socket and so it was put back in the box and stored. Already the hands on the temperature gauge were broken.
Her crowded exam room had a florescent light which did not work. She used a water tank with a spigot for hand washing. When I asked her whether things had improved or deteriorated for the three years she had been there, she paused and said, “Things have been changing.”
“Are they changing for the better or for the worse?”
“In what ways?”
She paused again and answered, “We didn’t used to have mattresses on the beds. A local politician bought mattresses for the Postnatal Ward and the Labor and Delivery Room. The women are more comfortable now.”
“But you don’t have mattresses for the Antenatal Ward.”
“We don’t use it.”
Apparently a request had been made for more florescent lights but this had been on hold because of a plan to eventually switch to energy saving light bulbs.
I asked, “What happened when your last light went out?”
“We ask the patient’s guardian to bring candles.”
“You deliver by candle light then?”
She laughed. I peered at this patient, long-suffering nurse who worked under such distressed condition and yet survived each day on the last leg of a florescent lamp.
A national commented, “Maintenance is a big problem.” This is not unique to Malawi, it is a common and chronic problem in much of Africa. He continued,” It will drain the whole budget of the district if funds are given to maintain this place.”
We observed the mid-wife taking meticulous care of each and every one of her pregnant woman, unhurried even way past the lunch hour. Mozambique is to the east of Tengani and Mozambicans cross the Shire River in dugout canoes and walk about 5 km to the health center. Here the Sena people live in Malawi and Mozambique and they speak a mixture of Chichewa and Sena. The boundary between the two countries blurs.
Outside the mid-wife’s room her patients sat on a bench, on the floor or lay on Chitenjes [patterned sarongs] waiting patiently for their turns to see her. Every single one of them had been tested for HIV. In any country patients would be up in arms to have to wait so long to see a doctor. Here in Malawi waiting for a long time is the norm.